Healthcare Provider Details

I. General information

NPI: 1639208739
Provider Name (Legal Business Name): AFFORDABLE CHIROPRACTIC CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 HODGSON RD
SHOREVIEW MN
55126-1949
US

IV. Provider business mailing address

4535 HODGSON RD
SHOREVIEW MN
55126-1949
US

V. Phone/Fax

Practice location:
  • Phone: 651-490-1507
  • Fax:
Mailing address:
  • Phone: 651-490-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2834
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DUANE JOHN
Title or Position: CHIROPRACTOR OWNER
Credential: D.C.
Phone: 651-490-1507